Provider Demographics
NPI:1558023531
Name:BAZ, ASLI (PSYD)
Entity Type:Individual
Prefix:
First Name:ASLI
Middle Name:
Last Name:BAZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16315 WAGNER WAY APT 210E
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5735
Mailing Address - Country:US
Mailing Address - Phone:312-684-8620
Mailing Address - Fax:
Practice Address - Street 1:16315 WAGNER WAY APT 210E
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5735
Practice Address - Country:US
Practice Address - Phone:312-684-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist